Potential driven electrochemical modification of tissue

ABSTRACT

The present invention relates to the use of electrochemistry to control and generate specific user defined chemical reactions in regions that may be defined by electrode placement and geometry. In one embodiment, the present invention provides a method of shape changing cartilage in a subject through potential-driven electrochemical modification of tissue (PDEMT) or use of a potential-driven electromechanical (EMR) device.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application claims the benefit of priority under 35 U.S.C.§119(e) of provisional application Ser. No. 61/824,299 filed on May 16,2013, the contents of which are hereby incorporated by reference.

GOVERNMENT RIGHTS

The U.S. Government has a paid-up license in this invention and theright in limited circumstances to require the patent owner to licenseothers on reasonable terms as provided for by the terms of Grant Nos.DR090349 awarded by the Department of Defense Deployment Related MedicalResearch Program and DE019026 awarded by the National Institutes ofHealth.

BACKGROUND

All publications herein are incorporated by reference to the same extentas if each individual publication or patent application was specificallyand individually indicated to be incorporated by reference. Thefollowing description includes information that may be useful inunderstanding the present invention. It is not an admission that any ofthe information provided herein is prior art or relevant to thepresently claimed invention, or that any publication specifically orimplicitly referenced is prior art.

There are several common cartilage malformations that patients sufferfrom that require tissue reconstruction and/or shaping cartilage. Forexample, in the head and neck, a patient could suffer from nasal tipdeformity, or a deviated septum, or a protuberant ear, or for example,stenotic trachea. All of the aforementioned conditions could possiblyrequire changing the shape of cartilage tissue of the patient as a formof treatment of the condition. However, changing the shape of tissuesuch as cartilage is conventionally accomplished using surgical methodsthat involve sutures, scalpels, incisions, and generally speaking, veryinvasive methods. Conventional surgical methods of reshaping tissuecould require open surgery, resulting in possibly substantial tissuedamage, as well as a high financial cost as well. Thus, alternativemethods are needed, and there is a need in the art for novel treatmentsand effective methods of shaping tissue.

BRIEF SUMMARY OF THE INVENTION

Various embodiments herein include a method of modifying a tissue,comprising providing an electrochemical interaction in a tissue, andmodifying the tissue by exploiting the electrochemical interaction. Inanother embodiment, exploiting the electrochemical interaction comprisesutilizing an electrochemical potentiostat to apply a specific electricalpotential to an array of electrodes. In another embodiment, theelectrodes are one or more needle electrodes inserted in the tissue. Inanother embodiment, exploiting the electrochemical interaction comprisespotential-driven electromechanical (EMR) and/or potential-drivenelectrochemical modification of tissue (PDEMT). In another embodiment,the electrochemical interaction is optimized based on the identificationand isolation of one or more discrete electrochemical reactions thatcause shape change of the tissue. In another embodiment, theelectrochemical interaction is optimized based on specific electricaldosimetry, electrode placement, and/or type of composition. In anotherembodiment, the tissue comprises a charged polymer hydrogel. In anotherembodiment, the tissue comprises cartilage. In another embodiment,modifying the tissue is changing the physical shape of the tissue. Inanother embodiment, modifying the tissue comprises changing physicalproperties. In another embodiment, changing physical properties includesmechanical behavior-static and dynamic, electrical behavior, opticalproperties, and/or thermal properties. In another embodiment, modifyingthe tissue comprises changing biological behavior. In anotherembodiment, changing biological behavior includes cell injury, celldeath, cell proliferation, shape change of the tissue, appearance of thetissue, and/or altering drug delivery properties of the tissue. Inanother embodiment, modification of the tissue is as part of an overalldrug treatment regimen. In another embodiment, the modification oftissue is performed in tandem with one or more defined changes inmechanical state in tissue, temperature of tissue, pressure,compression, and/or atmospheric and ambient conditions. In anotherembodiment, exploiting the electrochemical interaction in the subjectcomprises use of a system comprising one or more electrodes and acontrol system to apply a precise electrical potential.

Other embodiments include a method of treating a disease and/orcondition in a subject, comprising defining an electrochemicalinteraction in a constituent of a tissue and/or organ in a subject, andtreating the disease and/or condition by exploiting the electrochemicalinteraction in the subject. In another embodiment, exploiting theelectrochemical interaction results in altering the constituent ofliving tissue. In another embodiment, the constituent is of one or moreof the following: ligament, tendons, cornea, ear drum, temporalmandibular joint, vocal cord, muscle, skin, nerve, brain tissue, and/ortumors. In another embodiment, the constituent is of one or more of thefollowing: cartilage, bone, urine, and/or stool. In another embodiment,treating the disease and/or condition is the treatment of one or morebiologic contaminants. In another embodiment, the one or more biologiccontaminants include bacteria, fungi, molds, and/or viruses. In anotherembodiment, exploiting the electrochemical interaction in the subjectcomprises potential-driven electromechanical (EMR) and/orpotential-driven electrochemical modification of tissue (PDEMT). Inanother embodiment, the subject is a human. In another embodiment, thesubject is a rabbit. In another embodiment, exploiting theelectrochemical interaction in the subject further comprises placementof working, reference and auxillary electrodes in an effective geometricarrangement. In another embodiment, exploiting the electrochemicalinteraction in the subject comprises use of a system comprising one ormore electrodes and a control system to apply a precise electricalpotential.

Other embodiments include a system for exploiting an electrochemicalinteraction in a subject, comprising one or more electrodes, and acontrol system to apply a precise electrical potential. In anotherembodiment, the control system utilizes a potentiostatic control. Inanother embodiment, the control system utilizes a galvanostatic control.In another embodiment, the control system utilizes operation amplifiers.In another embodiment, the control system further comprises a feedbackcontrol. In another embodiment, the feedback control comprisesmonitoring tissue effect, change in mechanical properties, electricalproperties, or optical properties, and total charge transfer. In anotherembodiment, the feedback control comprises a measure and control ofcurrent, potential, charge transfer, pH, concentration of speciesgenerated by the system, and/or evolution of gases. In anotherembodiment, the one or more electrodes comprises a working, reference,and auxillary electrode. In another embodiment, the one or moreelectrodes have a static placement. In another embodiment, the one ormore electrodes are within a flow through cell. In another embodiment,the one or more electrodes have a shape that is needle, flat plate,curved, clamshell, complex, screen, foam, solid-stiff, soft, pliant,moldable, conforming, and/or liquid. In another embodiment, the one ormore electrodes are made from platinum, iridium, and/or graphite. Inanother embodiment, the one or more electrodes are coated with aplurality of oxidation catalysts. In another embodiment, the one or moreelectrodes comprise sequestered auxillary electrodes in an isolatedchamber connected by a salt bridge and/or luggin capillary. In anotherembodiment, the one or more electrodes are a reference electrode. Inanother embodiment, the one or more electrodes are composed of basemetals and electro-plated. In another embodiment, the applied preciseelectrical potential is modulated. In another embodiment, the appliedprecise electrical potential is modulated by pulsed, complex or simplewaveform, and/or on and off cycles. In another embodiment, the controlsystem is adapted for use in conjunction with open surgery, endoscopicdelivery, percutaneous, transmucosal, in an air environment, in anaqueous environment, image guided therapies to target specific tissuesand/or targets, biopsy, and/or tissue sampling. In another embodiment,the control system is used in tandem with one or more of the following:agents that activate a pro-genic drug, user created changes in tissuecomposition, injectable drugs, agents that produce cross-linking ofproteins, agents that alter pH, activate a catalyst for tissue effects,osmotically active agents, saline solutions, buffers, reactive oxygenscavengers, and chemicals that alter electrochemistry of the system. Inanother embodiment, the system further comprises a plurality of set ofelectrodes. In another embodiment, the plurality of set of electrodesare used simulatenously or at different times. In another embodiment,the plurality of set of electrodes are used at the same location orspaced apart. In another embodiment, the plurality of set of electrodesare in a multiplexing arrangement of the specific chemical reactiondesired. In another embodiment, the system further comprises using anelectrochemistry reaction to generate an active polymerization catalyst.In another embodiment, the electrochemistry reaction is described inFIG. 28 herein. In another embodiment, the system further comprisespolymerization of polyanaline, polypyrrole, and/or polythiophene.

Various embodiments include a method of shaping cartilage in a patient,comprising: providing a potential-driven electrochemical modification oftissue (PDEMT) and/or potential-driven electromechanical (EMR) device,and using the device to shape cartilage in the patient. In anotherembodiment, shaping cartilage includes facial structure, lengtheningand/or tightening ligaments and tendons, and/or correcting vision in thepatient. In another embodiment, cartilage is shaped by water hydrolysisthat results in protonation of fixed negative charges. In anotherembodiment, the method further comprises increasing tissue viability byminimizing pH gradients and/or ROS generation. In another embodiment,the device incorporates bipotentiostat and/or polypotentiostattechnology.

Other embodiments include a method of treating a cartilage malformationcondition in a patient, comprising providing potential-drivenelectrochemical modification of tissue (PDEMT) and/or potential-drivenelectromechanical (EMR) device, and treating the patient by using thedevice to shape cartilage. In another embodiment, the cartilagemalformation condition is a nasal tip deformity, deviated septum,protuberant ear, and/or stenotic trachea. In another embodiment, thedevice incorporates bipotentiostat and/or polypotentiostat technology.In another embodiment, shaping cartilage includes facial structure,lengthening and/or tightening ligaments and tendons, and/or correctingvision in the patient.

Other embodiments include an apparatus, comprising a potential-drivenelectrochemical modification of tissue (PDEMT) and/or potential-drivenelectromechanical (EMR) device adapted for shaping cartilage in apatient. In another embodiment, the device incorporates bipotentiostatand/or polypotentiostat technology.

Other features and advantages of the invention will become apparent fromthe following detailed description, taken in conjunction with theaccompanying drawings, which illustrate, by way of example, variousembodiments of the invention.

BRIEF DESCRIPTION OF THE FIGURES

Exemplary embodiments are illustrated in referenced figures. It isintended that the embodiments and figures disclosed herein are to beconsidered illustrative rather than restrictive.

FIG. 1 depicts, in accordance with embodiments herein, common cartilagemalformations of the head and neck.

FIG. 2 depicts, in accordance with embodiments herein, some conventionalsurgical methods for reshaping cartilage.

FIG. 3 depicts, in accordance with embodiments herein, some alternativemethods of cartilage reformation.

FIG. 4 depicts, in accordance with embodiments herein, some alternativemethods of cartilage reshaping.

FIG. 5 depicts, in accordance with embodiments herein, some practicallimitations of alternative methods of cartilage reformation.

FIG. 6 depicts, in accordance with embodiments herein, a diagram ofcartilage.

FIG. 7 depicts, in accordance with embodiments herein, charts of osmotic(swelling) pressure due to fixed charge density.

FIG. 8 depicts, in accordance with embodiments herein, donnan exclusionresults in cartilage permselectivity.

FIG. 9 depicts, in accordance with embodiments herein, possible EMRmechanisms.

FIG. 10 depicts, in accordance with embodiments herein,controlled-potential EMR.

FIG. 11 depicts, in accordance with embodiments herein, a possiblemechanism in accordance with embodiments herein, water oxidation andprotonation of FCD.

FIG. 12 depicts, in accordance with embodiments herein, electrolysis inPBS buffer at pH 7.4 (1.8 V vs. AgCl/Ag; 3 min; 0.3 C passed).

FIG. 13 depicts, in accordance with embodiments herein, shape-changedependence on anodic charge passed.

FIG. 14 depicts, in accordance with embodiments herein, role of tensionvs. compression stress relief on shape change.

FIG. 15 depicts, in accordance with embodiments herein, empiricallyderived pH-diffusion landscapes.

FIG. 16 depicts, in accordance with embodiments herein, possibility offlattening the pH gradient.

FIG. 17 depicts, in accordance with embodiments herein, possibility ofeliminating ROS production.

FIG. 18 depicts, in accordance with embodiments herein,electromechanical reshaping of rabbit ear (in vivo) using DC powersupply (battery), platinum needles, and acrylic jig.

FIG. 19 depicts, in accordance with embodiments herein, cartilagemalformations of the face. Specifically, (a) severe boxy nasal tipdeformity (pre op left, post op right); (b) deviated septum (left) andafter surgery—septoplasty (right); (c) severely protuberant ear (arrowsindicate lack of normal fold) and after surgery—otoplasty (right); (d)stenotic tracheal airway (before surgery-left, after-right). Arrowspoint toward regions of deviation or deformity.

FIG. 20 depicts, in accordance with embodiments herein, techniques toreshape the protuberant human ear. In conventional otoplasty surgery anincision (a) is made in posterior surface of ear. Then strategicallyplaced sutures (b) are used to create the desired curvature and surfacecontour of the ear. The anterior surface of the ear is shown (c) aftercurvature creation, and the typical layers of dressing (d) used tomaintain curvature for several weeks after surgery. In one example, EMRmay be used to reshape the ear is shown in (e) which illustrates theplacement of a moulage along the posterior surface of the ear (Arrow)and a series of dots indicating electrode placement (note—anteriorsurface forming a “clamshell” moulage is eliminated for clarity).Electrodes (f) are inserted along the region where reshaping (stressrelaxation) is desired.

FIG. 21 depicts, in accordance with embodiments herein, electrochemistryand molecular interaction during EMR. Proteoglycans (PTG) are chargedunder physiologic conditions, and the mechanical properties aredependent upon Coloumbic repulsion. During EMR several reactions occurat the anode, most notably the formation of H+, which can protonatecarboxyl and sulfonyl groups. Change in charge of these moieties resultsin local relaxation and transient softening of the tissue. Thegeneration of OH− in contrast may have a greater effect on tissueinjury.

FIG. 22 depicts, in accordance with embodiments herein, summary of EMRshape-change dependence on applied electrochemical potential (diagram,left) using rabbit septal cartilage and platinum-needle apparatus and abipotentiostat (schematic, inset). In each set of experiments, aconstant two-volt potential difference was maintained between the twoworking electrodes (W1 and W2), while the potentials themselves werepoised at successively more positive values vs. a AgCl/Ag reference.Note that in this arrangement, no current flows between W1 and W2. Onlywhen one or both electrodes were held positive of the water oxidationlimit did shape change occur. The cyclic voltammogram on the right sideof the diagram shows the i-V trace for PBS buffer at a platinum-needleelectrode: cathodic current at potentials negative of ˜−1 V correspondsto water reduction, while anodic current at potentials positive of ˜+1.4V corresponds to water oxidation.

FIG. 23 depicts, in accordance with embodiments herein, p-EMR data forrabbit septal cartilage using Pt-needle apparatus and applied potentialsof 1.6 V (black dots), 2.0 V (red dots), and 2.4 V (green dots) vs.AgCl/Ag. The graph shows the bend angle as a function of the anodiccharge passed. Inset: image of bent cartilage following 0.8 C passed.

FIG. 24 depicts, in accordance with embodiments herein, identificationof dosimetry for EMR as function of V and t. Specifically, (a) completedata set (unique for each electrode configuration) is obtained basedupon shape change alone (digital photography). (b) the data set isreduced by rejecting pairs that do not satisfy conditions for adequatemechanical stability. (c) Finally, only specimens with adequateviability (determined using confocal imaging) are candidates for in vivoevaluation. Figures are real data from experiments performed to optimizeanimal studies in voltage difference driven EMR.

FIG. 25 depicts, in accordance with embodiments herein, electrodes andjig design for performing EMR of cartilage. v-EMR is illustrated in (a)where both anode and cathode needle electrodes are inserted into tissuecreating parallel regions of tissue injury (b). In p-EMR, a potentiostatis used and reference and cathode electrodes are inserted (c), howevercathodic tissue injury may be limited to a small region around just oneelectrode (d) placed distally from the tissue bend. Cathodic injury tothe cartilage may be completely eliminated by using a electrolyte gel ina fritted electrode in contact with the cartilage (e), resulting in thecathodic reactions occurring gel which is “sacrificed.”

FIG. 26 depicts, in accordance with embodiments herein, electrochemicalinitiation of Fenton chemistry. In accordance with embodiments herein,the reaction provides an example of one of many chemical reactions thatillustrate singlet oxygen generation in this setting. In one embodiment,an iron-metal anode is used and oxidized in the presence of a peroxide.The oxidation produces Fe(II) locally, which reacts with the peroxidefor form radicals via the Fenton cycle.

FIG. 27 depicts, in accordance with embodiments herein, an example ofelectrochemical polymerization. Specifically, FIG. 27 depictspolymerization of polyanaline. Other examples include electrochemicalpolymerization of polypyrrole and polythiophene.

FIG. 28 depicts, in accordance with embodiments herein, an example ofusing electrochemistry to generate an active polymerization catalyst.

DESCRIPTION OF THE INVENTION

All references cited herein are incorporated by reference in theirentirety as though fully set forth. Unless defined otherwise, technicaland scientific terms used herein have the same meaning as commonlyunderstood by one of ordinary skill in the art to which this inventionbelongs. Singleton et al., Dictionary of Microbiology and MolecularBiology 4th ed., J. Wiley & Sons (New York, N.Y. 2012); March, AdvancedOrganic Chemistry Reactions, Mechanisms and Structure 5th ed., J. Wiley& Sons (New York, N.Y. 2001); and Sambrook and Russel, MolecularCloning: A Laboratory Manual 4th ed., Cold Spring Harbor LaboratoryPress (Cold Spring Harbor, N.Y. 2012); provide one skilled in the artwith a general guide to many of the terms used in the presentapplication. One skilled in the art will recognize many methods andmaterials similar or equivalent to those described herein, which couldbe used in the practice of the present invention. Indeed, the presentinvention is in no way limited to the methods and materials described.

As used herein, the abbreviation “PDEMT” refers to potential drivenelectrochemical modification of tissue.

As used herein, the abbreviation “EMR” means electromechanicalreshaping. In one embodiment, EMR provides non-thermal reshapingtechnique that combines mechanical deformation with the application oflow-level DC electric fields.

As disclosed herein, optimization of EMR (or PDEMT) for clinical userequires understanding the role of electrical potential rather thanvoltage differences, as one can isolate and identify the preciseelectrochemical reactions that cause events such as shape change ortissue injury. Instead of applying a large voltage difference betweentwo electrodes (v-EMR), potential-driven EMR (p-EMR) utilizes anelectrochemical potentiostat to apply a specific electrical potential toan array of electrodes where discrete electrochemical reactions can beisolated. Hence, reactions that favor shape change can be selected overthose that cause tissue injury. EMR capitalizes on the innate structureof cartilage as a charged polymer hydrogel, where part of theshape-change process is related to the interplay between chargedmacromolecular matrix components (proteoglycans), free ions, water, andelectrochemical reactions at the interface between tissue and electrode.p-EMR is an elegant, simple, minimally invasive, low-cost technology(e.g., needles, batteries) with the potential to become a clinicallyuseful surgical treatment modality as ubiquitous as the Bovie cautery,surgical stapler, or endoscope in reconstructive surgery.

For example, in accordance with various embodiments herein, cartilageforms the structural framework for the underlying key features of theface and supports the upper airway. The geometry and structure of theseframeworks within the ear, nose, larynx, or trachea can become malformedor destroyed as a consequence of trauma, congenital disease, or cancersurgery. EMR related techniques are well suited to alter the shape ofboth native tissue and autologous grafts obtained from heterotopicsites, and for the ear, nose, or septum, minimally invasive needle-basedtechniques could be used for in the office under local or regionalanesthesia.

As further disclosed herein, the inventors have studied the molecularbasis of EMR: most notably, they have established that EMR depends onspecific electrochemical reactions at the tissue/solution interface, andexamined the role of electrical potential rather than potentialdifference in the EMR process. With the molecular mechanism(s) of EMRfully characterized, the application of electric fields using p-EMR maybe tailored to select the specific reactions that create shape changewhile minimizing (or even eliminating) the reactions that cause tissuedamage and cell morbidity.

In one embodiment, the present invention provides a method of shapingcartilage tissue by using a minimally invasive, needle based approach.As further described herein, in one embodiment, it differs fromelectrochemical reshaping in that a potentiostat is incorporated tocontrol potential rather than simply applying voltage difference. Thiscan overcome a significant limitation in that specific chemicalreactions can be used for therapy and while others are rejected.

In one embodiment, the incorporation of potentiostat technology is usedto select specific electrochemical potentials to isolate specificchemical reactions. In another embodiment, the present invention is usedto choose between one anodic and/or cathodic half-reaction therebypotentially enhancing/diminishing undesirable outcomes. In anotherembodiment, the incorporation of a potentiostat is used for multipletissue electrodes. In another embodiment, the present invention is usedto contain and/or localize undesirable half-reactions to a site distalto an organ or tissue of interest (even with the use of a sacrificialelectrolyte outside the body, tissue, or organ).

In one embodiment, the technology allows for the use of chemicallymodified electrodes to further select specific electrochemical reactionsto optimize shape and mechanical properties change/minimize tissuedamage. The potentiostat can operate in modes where a constant voltageis applied, a constant current is applied, operating in galvanostaticmode, or a pulsed, alternating, or ramped application of voltage orcurrent is used to optimize the concentrations of electrochemicallygenerated species that affect tissue shape change. In anotherembodiment, the amount of electric charge transferred through eachelectrode of the bi-/multipotentiostat potential-drivenelectromechanical (EMR) and/or potential-driven electrochemicalmodification of tissue (PDEMT) system is monitored and controlled byswitching on/off individual electrodes and controlling appliedvoltage/current.

In other embodiments, the present invention provides a method of shapingcartilage in a patient, comprising providing a potential-drivenelectromechanical (EMR) and/or potential-driven electrochemicalmodification of tissue (PDEMT) device, and using the EMR and/or PDEMTdevice to shape cartilage in the patient. In another embodiment, shapingcartilage includes facial structure, lengthening and/or tighteningligaments and tendons, and/or correcting vision in the patient. Inanother embodiment, cartilage is shaped by water hydrolysis that resultsin protonation of fixed negative charges. In another embodiment, theinvention further comprises increasing tissue viability by minimizing pHgradients and/or ROS generation. In another embodiment, the deviceincorporates bipotentiostat and/or polypotentiostat technology.

Other embodiments include a method of treating a cartilage malformationcondition in a patient, comprising providing a potential-drivenelectromechanical (EMR) and/or potential-driven electrochemicalmodification of tissue (PDEMT) device, and treating the patient by usingthe PDEMT device to shape cartilage. In another embodiment, thecartilage malformation condition is a nasal tip deformity, deviatedseptum, protuberant ear, and/or stenotic trachea. In another embodiment,the device incorporates bipotentiostat and/or polypotentiostattechnology. In another embodiment, shaping cartilage includes facialstructure, lengthening and/or tightening ligaments and tendons, and/orcorrecting vision in the patient.

Other embodiments include an apparatus, comprising a potential-drivenelectromechanical (EMR) and/or potential-driven electrochemicalmodification of tissue (PDEMT) device adapted for shaping cartilage in apatient. In another embodiment, the device incorporates bipotentiostatand/or polypotentiostat technology.

In another embodiment, general surgical or medical device technology maybe used to deliver electrical charge or energy to living tissue tocreate in situ electrochemical reactions. In accordance with variousembodiments herein, the reactions can occur with any constituent ofliving tissue including macromolecules, proteins, etc. and tissue water.This includes cells as well. In another embodiment, the presentinvention provides use of electrochemistry to control and generatespecific user defined chemical reactions in regions defined by electrodeplacement and geometry. In another embodiment, the invention providesspecies (agent) selectivity and/or spatial selectivity. As readilyapparent to one of skill in the art, a variety of treatments andapplications in the human body that depend upon electrochemistry andthat require control and optimization may be used in conjunction withvarious embodiments herein. For example, interactions created can resultin the modification of a target tissue for medical therapeutic effectsincluding, change in physical properties (such as mechanicalbehavior-static and dynamic, electrical behavior, optical properties, orthermal properties), or changes in biologic behavior (such as cellinjury, cell death, cancer treatment, cell proliferation, shape changeof tissue, appearance of tissue, alter drug delivery properties oftissue). Or, for example, it may be performed in tandem with userimposed or defined changes in mechanical state in tissue (user definedstress-strain), temperature of tissue (heated or cooled),pressure/compression (internal stress), or atmospheric and ambientconditions.

In accordance with various embodiments herein, there are a variety oftherapeutic applications possible. For example, therapeutic applicationsmay include all soft tissues and organs including but not limited toligament and tendons, cornea, ear drum, temporal mandibular joint, vocalcord, muscle, skin, nerve, brain tissue, tumors and cancers. Or, forexample, therapeutic applications may also be directed toward cartilagesuch as may be found in joints, or in airways (ear, nose, throat), orbone, or components that flow such as blood, urine, and stool, allowingelectrochemical treatment of flowing constituents. In anotherembodiment, the present invention provides for eradication, control,and/or treatment of biologic contaminants including but not limited tobacteria, fungi, molds, and viruses.

As further described herein, in one embodiment the present inventionprovides for a system that controls the process of current delivery orpotential application. In another embodiment, the system has severalelectrodes including working, reference, and auxillary. These threeelectrodes can be placed into tissue in varying geometric arrangements.In another embodiment, there may be more than one of each of these typesof electrodes within a therapeutic system. As apparent to one of skillin the art, any number of electrode shapes and materials are readilyavailable and may be used in conjunction with various embodimentsherein. For example, the electrode can be static or within a flowthrough cell, or in the shape of needles, flat plates, complex shapes(such as curves, or clamshell), screens, foams, solid-stiff, soft,pliant, moldable, conforming, or liquid (such as mercury, and otheralloys). Or, for example, electrodes could be made of platinum, iridium,graphite, coated with oxidation catalysts, sequestered auxillaryelectrodes in an isolated chamber connected by a salt bridge or Luggincapillary, reference electrode, or composed of base metals andelectro-plated. Similarly, the electrodes may be placed in any number ofuseful geometric arrangements. For example, in one embodiment, working,reference, and auxiliary electrodes may all be placed within the tissuein either close proximity or at a distance from one another. Or, inanother embodiment, an array of working electrodes may be fashioned tocover a large or unique region of interest. In another embodiment, thereference electrode may not interact directly with tissue of interest(e.g. separated by a Luggin capillary or salt bridge). In anotherembodiment, the auxiliary electrode may not interact directly withtissue of interest (e.g. separated by a Luggin capillary or saltbridge). In another embodiment, the electrical current, charge transfer,and/or potential are modulated. In another embodiment, modulationincludes pulsed, complex or simple waveform, and/or on and off cycles.In accordance with various embodiments herein, more than one system orset of electrodes can be used, which can include simultaneously or atdifferent times, or at the same location or spaced apart with variableor constant distances, or multiplexing of the specific chemical reactiondesired.

As further disclosed herein, the system that controls the process ofcurrent delivery or potential application may also include one or morecontrol system instrumentations. As readily apparent to one of skill inthe art, there are a variety of available devices and systems that maybe used to provide control instrumentation, as well as any number ofelements that may be desired to be monitored and controlled inaccordance with various embodiments herein. In one embodiment, thecontrol system instrumentation is a poteniostatic control. In anotherembodiment, poteniostatic includes biopotentiostats. In anotherembodiment, the potential is specified by the user. In anotherembodiment, the control system is a galvanostatic control, where theuser can specify certain amounts of current, and potential will be setto establish that current. In another embodiment, simple operationamplifiers can function to accomplish the task of a poteniostatic and/orgalvanostatic control. In another embodiment, the system furtherincludes a feedback control. This may include control of tissue effect,where biophysical change can be monitored and information used tocontrol current and/or potential. Or, for example feedback control mayinclude monitored variables that mechanical properties, electricalproperties, and optical properties. In another embodiment, total chargetransfer is also monitored. In accordance with various embodimentsherein, control system instrumentation may be used to measure and/orcontrol one or more of the following: current, potential, chargetransfer, pH, concentration of various species generated by the device,and/or the evolution of gases.

In another embodiment, the device is designed for use in one or more ofthe following: open surgery, endoscopic delivery, percutaneous, transmucosal, in air and in aqueous environments, combined with image guidedtherapies to target specific tissues/targets, or perform simultaneousfunctions such as biopsy and tissue sampling. In accordance with variousembodiments herein, the device may be used in tandem with one or moreagents that activate a pro-genic drug (e.g. tumorcidal). This mayinclude, for example, reactive oxygen specifies, generate in situspecies, or the circumstance where the drug is activated only invicinity of appropriate/extreme user defined electrical potential.Defined electrical potential may include, for example, creating spatialselectivity based electric field, or isolate deleterious or desiredreaction to what is defined by electrode placement geometry. Inaccordance with various embodiments herein, the device may be used intandem with user created changes in tissue composition, injectabledrugs, agents that produce cross-linking of proteins, agents that alterpH, or activate a catalyst for tissue effects including glue,tumorcidal, or mechanical property change, etc. Similarly, the devicemay be used in tandem with one or more of the following: osmoticallyactive agents, saline solutions (hyper and hypotonic), buffers, reactiveoxygen scavengers, and other chemicals that change or alterelectrochemistry of the system.

The various methods and techniques described above provide a number ofways to carry out the invention. Of course, it is to be understood thatnot necessarily all objectives or advantages described may be achievedin accordance with any particular embodiment described herein. Thus, forexample, those skilled in the art will recognize that the methods can beperformed in a manner that achieves or optimizes one advantage or groupof advantages as taught herein without necessarily achieving otherobjectives or advantages as may be taught or suggested herein. A varietyof advantageous and disadvantageous alternatives are mentioned herein.It is to be understood that some preferred embodiments specificallyinclude one, another, or several advantageous features, while othersspecifically exclude one, another, or several disadvantageous features,while still others specifically mitigate a present disadvantageousfeature by inclusion of one, another, or several advantageous features.Furthermore, the skilled artisan will recognize the applicability ofvarious features from different embodiments. Similarly, the variouselements, features and steps discussed above, as well as other knownequivalents for each such element, feature or step, can be mixed andmatched by one of ordinary skill in this art to perform methods inaccordance with principles described herein. Among the various elements,features, and steps some will be specifically included and othersspecifically excluded in diverse embodiments.

Although the invention has been disclosed in the context of certainembodiments and examples, it will be understood by those skilled in theart that the embodiments of the invention extend beyond the specificallydisclosed embodiments to other alternative embodiments and/or uses andmodifications and equivalents thereof.

Many variations and alternative elements have been disclosed inembodiments of the present invention. Still further variations andalternate elements will be apparent to one of skill in the art. Amongthese variations, without limitation, are the selection of constituentmodules for the inventive compositions, and the diseases and otherclinical conditions that may be diagnosed, prognosed or treatedtherewith. Various embodiments of the invention can specifically includeor exclude any of these variations or elements.

In some embodiments, the numbers expressing quantities of ingredients,properties such as concentration, reaction conditions, and so forth,used to describe and claim certain embodiments of the invention are tobe understood as being modified in some instances by the term “about.”Accordingly, in some embodiments, the numerical parameters set forth inthe written description and attached claims are approximations that canvary depending upon the desired properties sought to be obtained by aparticular embodiment. In some embodiments, the numerical parametersshould be construed in light of the number of reported significantdigits and by applying ordinary rounding techniques. Notwithstandingthat the numerical ranges and parameters setting forth the broad scopeof some embodiments of the invention are approximations, the numericalvalues set forth in the specific examples are reported as precisely aspracticable. The numerical values presented in some embodiments of theinvention may contain certain errors necessarily resulting from thestandard deviation found in their respective testing measurements.

In some embodiments, the terms “a” and “an” and “the” and similarreferences used in the context of describing a particular embodiment ofthe invention (especially in the context of certain of the followingclaims) can be construed to cover both the singular and the plural. Therecitation of ranges of values herein is merely intended to serve as ashorthand method of referring individually to each separate valuefalling within the range. Unless otherwise indicated herein, eachindividual value is incorporated into the specification as if it wereindividually recited herein. All methods described herein can beperformed in any suitable order unless otherwise indicated herein orotherwise clearly contradicted by context. The use of any and allexamples, or exemplary language (e.g. “such as”) provided with respectto certain embodiments herein is intended merely to better illuminatethe invention and does not pose a limitation on the scope of theinvention otherwise claimed. No language in the specification should beconstrued as indicating any non-claimed element essential to thepractice of the invention.

Groupings of alternative elements or embodiments of the inventiondisclosed herein are not to be construed as limitations. Each groupmember can be referred to and claimed individually or in any combinationwith other members of the group or other elements found herein. One ormore members of a group can be included in, or deleted from, a group forreasons of convenience and/or patentability. When any such inclusion ordeletion occurs, the specification is herein deemed to contain the groupas modified thus fulfilling the written description of all Markushgroups used in the appended claims.

Preferred embodiments of this invention are described herein, includingthe best mode known to the inventors for carrying out the invention.Variations on those preferred embodiments will become apparent to thoseof ordinary skill in the art upon reading the foregoing description. Itis contemplated that skilled artisans can employ such variations asappropriate, and the invention can be practiced otherwise thanspecifically described herein. Accordingly, many embodiments of thisinvention include all modifications and equivalents of the subjectmatter recited in the claims appended hereto as permitted by applicablelaw. Moreover, any combination of the above-described elements in allpossible variations thereof is encompassed by the invention unlessotherwise indicated herein or otherwise clearly contradicted by context.

Furthermore, numerous references have been made to patents and printedpublications throughout this specification. Each of the above citedreferences and printed publications are herein individually incorporatedby reference in their entirety.

In closing, it is to be understood that the embodiments of the inventiondisclosed herein are illustrative of the principles of the presentinvention. Other modifications that can be employed can be within thescope of the invention. Thus, by way of example, but not of limitation,alternative configurations of the present invention can be utilized inaccordance with the teachings herein. Accordingly, embodiments of thepresent invention are not limited to that precisely as shown anddescribed.

EXAMPLES

The following examples are provided to better illustrate the claimedinvention and are not to be interpreted as limiting the scope of theinvention. To the extent that specific materials are mentioned, it ismerely for purposes of illustration and is not intended to limit theinvention. One skilled in the art may develop equivalent means orreactants without the exercise of inventive capacity and withoutdeparting from the scope of the invention.

Example 1 Overview

In one embodiment, potential driven electrochemical modification oftissue (PDEMT) is a technology that can be used to create discreteelectrochemical reactions in tissue. In one embodiment, a potentiostatis employed to select and control the specific electrochemical reactionsthat occur at an electrode-tissue interface. A potentiostat is theelectronic hardware based upon operational amplifiers, and is requiredto control a three electrode cell and run most electroanalyticalexperiments. A bipotentiostat and polypotentiostat are potentiostatscapable of controlling two working electrodes and more than two workingelectrodes, respectively. PDEMT implicitly is a new treatment modalitythat relies upon control of redox chemistry. Redox reactions, oroxidation-reduction reactions, have a number of similarities toacid-base reactions. Like acid-base reactions, redox reactions are amatched set, that is, there cannot be an oxidation reaction without areduction reaction happening simultaneously. The oxidation alone and thereduction alone are each called a half-reaction, because twohalf-reactions always occur together to form a whole reaction. Whenwriting half-reactions, the gained or lost electrons are typicallyincluded explicitly in order that the half-reaction be balanced withrespect to electric charge. A potentiostat allows the separation of thetwo half-reactions spatially which is important, as in living tissuesthe major redox reaction that occurs with PDEMT is the electrolysis ofwater. Complex species may be generated with hydrolysis and PDEMTpermits a means to isolate desirable reactions and reduce or eliminatethose which are deleterious.

Example 2 Incorporation of Potentiostat Technology

The incorporation of potentiostat technology is important inimplementation of this technology as one may a) select specificelectrochemical potentials to isolate specific chemical reactions; b)choose between one anodic and/or cathodic half-reaction therebypotentially enhancing/diminishing undesirable outcomes; c) use ofmultiple tissue electrodes; and d) potential to contain/localizeundesirable half-reactions to a site distal to the organ or tissue ofinterest (even with the use of a sacrificial electrolyte outside thebody, tissue, or organ). The technology additionally allows for the useof chemically modified electrodes to further select specificelectrochemical reactions to optimize shape and mechanical propertieschange/minimize tissue damage. The potentiostat can operate in modeswhere a constant voltage is applied, a constant current is applied(operating in galvanostatic mode), or a pulsed, alternating, or rampedapplication of voltage or current is used to optimize the concentrationsof electrochemically generated species that affect tissue shape change.In addition, amount of electric charge transferred through eachelectrode of the bi-/multipotentiostat PDEMT system can be monitored andcontrolled by switching on/off individual electrodes and controllingapplied voltage/current.

Example 3 Conclusions

Potential-driven electrochemical modification of tissue (PDEMT) can beused to alter the mechanical structure of living tissues. This wouldinclude soft tissue like skin, cartilage, tendon, ligament, cornea,muscle, and others. Using this technology, tissue can be stretched,shortened, bended, curved, strengthened, and weakened. Also, thistechnology can be used to focally create electrochemical changes locallyin tissue as well. Direct application includes the alteration ofcartilage to change facial structure, the lengthening or tightening oftendons and ligaments, and the correction of vision. This technologycreates electrochemical changes in tissue using a unique means tocontrol the delivery of electrical energy and create specificuser-defined electrochemical reactions in localized or diffuse regionsin the tissue. The technology allows separation of anodic and cathodicredox chemistry reactions to distinct sites that may be adjacent to oneanother or separated spatially. This relies upon principles ofelectrochemistry to alter the complex chemical milieu in living tissueto achieve structural changes and macromolecular alters in the matrix.EMR is an effective and non-invasive method to restructure cartilagetissue, with a dominant mechanism of shape change involving waterhydrolysis that results in protonation of fixed negative charges.Additional efforts may be made to minimize pH gradients/ROS generationto further increase tissue viability following EMR.

Example 4 p-EMR

For more than a century, surgeons have envisioned reshaping tissuewithout the use of scalpels and sutures. Recently, novel laser sourcesand innovative radiofrequency (RF) devices have brought this visioncloser to reality through the development of minimally invasive devicesfor treating skin and other tissues. The functional and aestheticdefects in the head, neck, and airway that result from cancer surgery,trauma, or congenital malformations require surgical techniques toreshape cartilage in order to restore or recreate damaged or absentstructures. Conventional surgical techniques include numerous maneuversbased on carving, morselizing, scoring, or suturing native cartilagetissue. However, the disadvantages of these approaches include donorsite morbidity from graft harvest, waste of excess graft tissue, shapememory effects, lack of control over warping (rib cartilage grafts), andthe need for anesthesia, scalpels, sutures, and open surgery.

Techniques for reshaping living tissues often rely upon controlled heatgeneration to denature, remodel, and/or accelerate stress relaxation,exploiting the thermoviscoelasticity common to all collagenous tissues.However, in contrast, electromechanical reshaping (EMR) is a non-thermalreshaping technique that can combine mechanical deformation with theapplication of low-level DC electric fields. As further disclosedherein, shape change is driven by electrochemical reactions that mayoccur between surface or needle electrodes placed in contact with orinserted into mechanically deformed specimens.

In a simple embodiment of EMR, namely voltage difference-driven EMR orv-EMR, an intact rabbit ear (FIG. 18 a) is held in mechanicaldeformation by a jig (18 b, c). Paired needle electrodes are insertedthrough the jig and skin into the ear cartilage, and then connected to aDC power supply for 2-3 minutes (18 c). The jigs are then removed, andthe ear assumes a new shape, which in this case is a 90° bend (18 d).Significantly, the temperature increase during reshaping is negligible(˜1° C.), which indicates that the mechanism is not due to simpleresistive heating. Because the power requirements are extremely small,EMR can be accomplished using disposable batteries as a power source andsimple needle electrodes inserted into a mechanically deformed structuresuch as the ear; these costs are on par with sutures and scalpel blades.Animal studies show that the reshaped ear flexes and behavesmechanically like native tissue.

Optimization of EMR for clinical use requires understanding the role ofelectrical potential rather than voltage differences, as one can isolateand identify the precise electrochemical reactions that cause eventssuch as shape change or tissue injury. Instead of applying a largevoltage difference between two electrodes (v-EMR), potential-driven EMR(p-EMR) utilizes an electrochemical potentiostat to apply a specificelectrical potential to an array of electrodes where discreteelectrochemical reactions can be isolated. Hence, reactions that favorshape change can be selected over those that cause tissue injury. EMRcapitalizes on the innate structure of cartilage as a charged polymerhydrogel, where part of the shape-change process is related to theinterplay between charged macromolecular matrix components(proteoglycans), free ions, water, and electrochemical reactions at theinterface between tissue and electrode. p-EMR is an elegant, simple,minimally invasive, low-cost technology (e.g., needles, batteries) withthe potential to become a clinically useful surgical treatment modalityas ubiquitous as the Bovie cautery, surgical stapler, or endoscope inreconstructive surgery.

Cartilage forms the structural framework for the underlying key featuresof the face and supports the upper airway. The geometry and structure ofthese frameworks within the ear, nose, larynx, or trachea can becomemalformed or destroyed as a consequence of trauma, congenital disease,or cancer surgery. To correct these defects, surgery often is needed toalter the shape of these existing cartilaginous structures or the shapeof cartilage graft material obtained from heterotopic sites (e.g., rib,ear, septum). Cartilage reshaping is needed to correct four majorproblems in the head and neck (FIG. 19), namely: structural deformitiesof the nose a) (currently accomplished by performing rhinoplastyoperations; b) nasal airway deformities (e.g., septal deviations,treated with septoplasty) c) prominent/protuberant or malformed ears;and d) acquired subglottic or tracheal stenosis (corrected via manygrafting operations). Treatment of each of these conditions requirescartilage reshaping, and the extent of shape change depends on thenature of the defect or deformity. However, the methods used toaccomplish these tasks have not changed in decades, and surgeons stillrely mainly upon classic surgical techniques (scoring, cutting,suturing). Conventional surgery requires skin or mucosal incisions,almost always general anesthesia, longer operative times and recovery,and additional loss of time from work. EMR related techniques are wellsuited to alter the shape of both native tissue and autologous graftsobtained from heterotopic sites, and for the ear, nose, or septum,minimally invasive needle-based techniques could be used for in theoffice under local or regional anesthesia.

In terms of economic impact, one of the greatest needs for a new,minimally invasive cartilage-reshaping technique is in the management ofnasal and septal deformities (FIG. 19 a-b). More than 250,000septoplasty and 360,000 rhinoplasty operations are performed each year,either to treat nasal airway obstruction or to correct externaldeformities. In both operations, general anesthesia is normally used,incisions are made, and cartilage is cut, excised, or sutured to alterinternal or external nasal shape. Patients miss at least one week ofwork. The need to develop a simpler office-based method that does notrely upon classic surgical techniques (incisions, sutures, etc.) isclear when the total economic costs of anesthesia, operating room time(estimated to cost an average $1.00/second), nursing and support staff,and surgical fees are tabulated (the total direct costs for conventionalnasal surgery is approximately $10,000 per patient; in contrast, thedirect costs for most office-based nasal procedures is under $500). EMR,perhaps embodied as a transmucosal/percutaneous needle or probeelectrode-based procedure, could potentially be used as a minimallyinvasive method to reshape cartilage, analogous to that used for lasernasal septum reshaping or auricular cartilage reshaping in the office.

In terms of dramatic impact on patients' lives, correcting the spectrumof congenital external ear malformations in young children that includeprominent and protuberant ears (FIG. 19 c) is also a target applicationfor EMR related techniques and devices. Needle EMR electrodes combinedwith moulages or molds to hold the ear in mechanical deformation canreplace the innumerable otoplasty and auricular reconstructionoperations aimed at restoring normal morphology, and reduce the relianceupon surgical skill and technique. Overall, the incidence of externalear deformities in the general population exceeds 5%, and is observed inabout 1 in 5,000 live births. The simplest and most common malformationoccurs when the antihelical crease of the pinna is missing (FIG. 19 c,left); left uncorrected, the deformity generally leads to viciousridicule and teasing when the child reaches school age. Correction,while seemingly simple, is a technically demanding process and reliesupon expertly placed cartilage-splitting incisions and/or retentionsutures to recreate normal anatomy. FIG. 20 herein is a montage ofconventional otoplasty (a-d) compared to a hypothetical EMR driven earreshaping procedure (e-f). In conventional otoplasty surgery, anincision is made along the posterior surface of the ear and skin isdissected and removed to expose the cartilage framework (a). Thenprecisely placed sutures (b) are used to create the desired curvatureand contour. Sutures generally do not resorb and are under significanttension as they must resist the elastic forces generated that resistdeformation. Using these techniques the new curvature of the ear iscreated (c). As considerable tension exists, dressings to maintaincartilage shape (d) are required to be worn by the patient from 1-12weeks varying widely based upon surgeon preferences. In contrast, EMRcould require the ear to be mouled using a two part clamshell-like jig(only one-half shown in (e) for clarity purposes, through whichelectrodes (f) would be inserted into the cartilage. Once current flowsto the electrode, the entire EMR process could take only minutes, afterwhich the moulages would be removed and the ear would retain its newshape. This same general EMR approach could be applied to less complexmalformations, such as the “bat” or “shell” ear deformities. Tissuereshaping methods are more than just a nascent technology, as alreadymuch more expensive laser ear-reshaping systems are now penetrating themarketplace.

Although they are less common than either nasal or auriculardeformities, acquired tracheal malformations may also be treated by EMR(FIG. 19 d). Tracheal and subglottic stenosis in adult and pediatricpopulations are exceedingly difficult deformities to treat and correctusing conventional surgical methods. Tracheal stenosis and relatedmalformations are vexing surgical problems of the upper airway thatresult from the aggressive development of technology aimed at preservingand prolonging life in both adult and neonatal ICUs, and that develop asa consequence of the extensive use of endotracheal intubation forventilatory support. Although aggressive ICU care prolongs life, it hasled to an increase in the rate of acquired tracheal stenosis, estimatedto be between 1 and 8% in the neonatal ICU “graduate” population.Correction of the stenotic tracheal airway generally requires a complexsequence of operations that may involve dilation, laser resection ofcartilage, open operations with cartilage graft harvest and placement,or segmental resection. In one embodiment, one possible method to applyEMR would be the development of a needle base system to reshape tissuelocally and combine this with short term stent placement—all performedendoscopically by pediatric ENT surgeons.

Presently, surgeons must cut, carve, morselize, or suture cartilage inorder to balance the forces generated in the matrix that resistdeformation, and these maneuvers require classic open operations, withall the attendant medical risks and increased economic costs of generalanesthesia. Recently, a number of thermally mediated procedures havebeen introduced to replace classic operations in otolaryngology,ophthalmology, plastic surgery, urology, orthopedics, andgastroenterology. However, thermoforming of living tissue exploits thethermoviscoelastic properties inherent within collagen, relying uponheat to produce shape change using laser or RF sources, and has obviousdisadvantages in that the desired outcome of shape change must bebalanced with the risks of thermal necrosis. In contrast, EMR does notrely upon resistive heat generation, but rather exploits the molecularproperties of the cartilage to alter its mechanical state in response tochanges in the electrical and chemical milieu that interacts with itscharged tissue matrix. EMR is an ultra-low cost, needle-based therapythat can be implemented using only local anesthetics in mostapplications, and is suitable for office-based procedures. It representsa paradigm shift in that only electrochemical interactions in tissue areexploited to alter the material properties of proteoglycan rich,collagenous tissues, leading to a safe approach to cartilage reshaping.p-EMR, in particular, represents a significant move away from “cut andsuture” surgery toward in situ techniques that exploit preciselycontrolled chemical reactions to restructure tissue at the molecularlevel. In addition to cartilage tissue, EMR can be used to alter themechanical behavior of tendon and ligament (tightening) and cornea(reshaping) as well, for example. In addition to the simple needleelectrodes and power supplies (e.g., disposable batteries) used forv-EMR, p-EMR may also include an operational amplifier-based circuit forthe application of a controlled potential. Thus the p-EMR embodiment ofthis therapy is low cost and amenable to single-use applications(disposable components); indeed, because the potentiostat can becomputer controlled, algorithms for the optimal p-EMR conditions can bepre-programmed into the clinical device to reduce the reliance of goodsurgical outcome on the individual surgeon's technical skill, much inthe model of LASIK cornea reshaping (albeit at a minute fraction of thecost).

Because EMR is, at the molecular level, a consequence ofelectrode-driven chemical reactions, it builds upon a knowledge basederived from nearly a century of chemistry research in electrochemicalprocesses. That basic research has played key roles in developingindustrial technologies ranging from the lithium-ion battery to personalglucose monitors. It is notable that both major professionalelectrochemical societies—the International Society of Electrochemistry(ISE) and the Electrochemical Society (ECS)—have formal divisions inbioelectrochemistry, yet those divisions focus largely on theelectrochemical properties of individual biomolecules (proteins andDNA), or on the development of electrochemical assays for drugmetabolites and other molecular markers. The application of modernelectroanalytical methods to investigate the effects of electrochemicalreactions on macroscopic tissue is virtually unheard of, and offers aninnovative model at the interface of basic chemistry, biomedicalengineering, and medicine. EMR has the potential to revolutionize thereshaping of cartilage tissue and change the treatment of cartilaginousdeformities in the head, neck, and upper airway.

The inventors have studied the molecular basis of EMR: most notably,they have established that EMR depends on specific electrochemicalreactions at the tissue/solution interface, and examined the role ofelectrical potential rather than potential difference in the EMRprocess. With the molecular mechanism(s) of EMR fully characterized, theapplication of electric fields using p-EMR may be tailored to select thespecific reactions that create shape change while minimizing (or eveneliminating) the reactions that cause tissue damage and cell morbidity.

Understanding the underlying molecular mechanism(s) of cartilage EMR isof singular importance to commercializing the reshaping process.Although several possible mechanisms may play a role (e.g., non-Faradaicprotein and/or ion migration through the tissue caused by appliedvoltage gradients), the inventors' work supports that the dominantpathway involves water electrolysis and acidification at thetissue/solution interface. Over the voltage ranges examined in theinventors' previous studies, water and chloride are the main speciesthat undergo redox chemistry. FIG. 21 briefly provides an overview ofthe electrochemistry and molecular interactions that accompany EMR. Notethat chlorine itself does not build up in solution; it is released as agas or forms hypochlorite instead.

In order to better control the electrochemical parameters of the p-EMRprocess, the inventors carried out a series of electrolysis experimentsusing a bipotentiostat/galvanostat. A four-electrode arrangement (FIG.22) allows control both of the potential difference between two workingelectrodes (as in v-EMR), as well as the actual applied potentials(p-EMR) relative to a known reference couple (e.g., AgCl/Ag). Moreover,the bipotentiostat directs current flow between the working electrodes(that are in contact with the cartilage) and a counter electrode thatcan be positioned far (up to several cm) from the tissue. Thus, incontrast to some previous studies, these experiments do not involvecurrent flow through the tissue sample. This electrode configurationtherefore allows one to decouple the effects of current flow on EMR fromthe effects of applied electrochemical potentials.

Using a platinum-needle EMR apparatus, the inventors performed a seriesof reshaping experiments on rabbit septal cartilage in which two sets ofworking electrodes were held at a constant potential difference (2 V)relative to one another, while the midpoint of those potentials wasscanned between ±1 V relative to AgCl/Ag, (FIG. 21). Significantly,p-EMR occurred only when the potential of at least one set of workingelectrodes was held positive of the anodic solvent limit. Hence theseresults indicate that no potential gradient across the tissue isrequired for p-EMR: reshaping is just as effective when both workingelectrodes are held at the same value, as long as that value is positiveof the water-oxidation threshold. This is of critical importance as thecathode reactions produce hydroxide [OH-], and base is well known to bemore damaging to soft tissues than acid.

The inventors provide herein compelling evidence that EMR is a result ofelectrochemical reactions that occur upon oxidation of water/electrolyteat the electrode/tissue interface: (1) no EMR occurs unless at least oneelectrode in contact with the cartilage is held at a potential positiveof the water-oxidation limit; (2) EMR does not require a voltagegradient across the tissue; and (3) the magnitude of EMR correlatesdirectly with total anodic charge transferred (as opposed toelectrolysis time, applied potential, voltage gradient, etc. (FIG. 23).This suggests that EMR relies on diffusion into the tissue of keyanalytes generated during anodic electrolysis. Significantly, wateroxidation (as well as chloride oxidation in aqueous media) results inthe electrochemical production of H+, whose concentration increasesproportionately with the charge passed. Acidification at the anode andsubsequent diffusion of protons into the tissue may be the dominantprocess responsible for the shape change. Protonation of immobilizedanions within the proteoglycan matrix disrupts the ionic-bonding networkthat provides structural integrity to the tissue. This, in turn,relieves the strain imposed by mechanical deformation. Subsequentre-equilibration to physiological pH restores the immobilized negativecharges after molecules have locally “shifted” and reestablishes theionic-bonding matrix, resulting in sustained shape change of the tissue.It is noteworthy that this general mechanism is fully consistent withthe observation that EMR persists ex vivo only if samples are pHre-equilibrated in buffer after electrolysis.

In accordance with various embodiments herein, the present inventionprovides for mapping EMR-induced pH landscapes within cartilage tissue.Under the experimental conditions (applied potential, current density,and electrolysis times) used for p-EMR, homogeneous diffusion throughPBS buffer of protons generated at the electrode, result in very lowpH's (<˜2), with the pH gradient extending 1-2 millimeters into thesolution. Modeling proton diffusion through the highly heterogeneoustissue matrix, however, is complicated, as little is known about thedielectric properties of cartilage, which likely change with pH. Mappingthe pH gradients by direct measurement of the tissue pH as a function ofdistance, time, and applied potential is therefore more tractable. Basedon the effective pKa's of the acidic forms of chondroitan and keratinsulfate, and the hyaluranan chains of the matrix proteoglycans, it maybe estimated that a pH range near 2-3 would be required to protonate thefixed negative charges of the cartilage tissue. From the menu ofpH-indicating dyes active in that regime, screening has revealed atleast three that show no redox activity at the potentials required forp-EMR: thymol blue, bromophenol blue, and quinaldine red. In experimentsusing cartilage tissue infused with thymol blue, anodic electrolysisshows the clear evolution of a color change migrating from the Pt-needleanode as the pH gradient moves through the gel. The change in color isreadily monitored with a digital camera and compared with the referencecolor images of stained cartilage samples maintained at known acidity,so pH as a function of distance can be mapped and correlated to anodiccharge (and to EMR shape change). Using a series of dyes covering the0-7 pH range, one can accurately map pH over a wide acidity range toconstruct an experimentally derived landscape of the tissue pH at anydistance and time. This “working curve” may be used to develop protocolsfor optimizing the electrolysis conditions to give pH gradients thatboth maximize shape change while potentially minimizing tissue damage.

Because pH staining is independent of the specific p-EMR protocol used,it can provide useful feedback data to alter and refine the p-EMRelectrolysis conditions—for example, by applying different electrolysiswaveforms (AC vs. DC). Electrochemical pH sensors based onultra-microelectrodes inserted into the cartilage (using the pHdependence of hydrogen evolution under galvanostatic control as thereporting element) may also be engineered, or using fiber-optic pHprobes.

If chloride oxidation limits tissue viability, one might use alternativeelectrode materials for p-EMR. For example, IrO2 has been identified asone of the best surfaces to carry out the 4e-oxidation of water as itcan move the potential threshold from our empirical value of ˜1.6 V vs.AgCl/Ag at platinum to near the thermodynamic value, ˜0.75 V vs.AgCl/Ag—which is nearly ½ volt negative of the chloride potential. Thiswould effectively eliminate both ROS production and chloride oxidation.

As shape change comes at the expense of cell injury, the optimizationmay require identification and selection of the appropriate appliedpotential (V), duration (t), electrode composition, and needle electrodeplacement. Combinations of these parameters determine resultant shapechange, mechanical stability and tissue viability in a cartilagespecimen, which are the clinically relevant factors to thereconstructive surgeon (FIG. 24). Analysis may begin with digitalphotography, and bend angle measured and plotted as a function ofpotential, electrolysis time, etc. Mechanical stability then measuredusing flexural mechanical analysis. Viability determined using laserscanning confocal microscopy combined with live-dead assay fluorescentdyes. Electrode placement is constrained by the demand that theshape-change effect occur in regions of increased internal stressproduced by the mechanical deformation of the specimen. For a givenelectrode composition and placement, each V, t combination produces aunique bend angle after EMR (24 a). However, not all reshaped specimenswill satisfy the criteria for adequate shape change. If mechanicalstability is introduced as a second criterion, then the parameter setfor V, t, is further reduced (FIG. 24 b). Finally, applying tissueviability as a third criterion, the parameter set is even furtherrefined (FIG. 24 c). One may also identify a reduced parameter set forp-EMR using shape change and mechanical stability as the outcomemeasures in ex vivo rabbit nasal septal cartilage tissue for eachsuitable candidate electrode material. One could further reduce theparameter set by adding viability as the final factor in the selectionprocess. The task at hand is to strike a balance between effective shapechange, mechanical stability, and tissue injury.

Various embodiments of the invention are described above in the DetailedDescription. While these descriptions directly describe the aboveembodiments, it is understood that those skilled in the art may conceivemodifications and/or variations to the specific embodiments shown anddescribed herein. Any such modifications or variations that fall withinthe purview of this description are intended to be included therein aswell. Unless specifically noted, it is the intention of the inventorsthat the words and phrases in the specification and claims be given theordinary and accustomed meanings to those of ordinary skill in theapplicable art(s). The foregoing description of various embodiments ofthe invention known to the applicant at this time of filing theapplication has been presented and is intended for the purposes ofillustration and description. The present description is not intended tobe exhaustive nor limit the invention to the precise form disclosed andmany modifications and variations are possible in the light of the aboveteachings. The embodiments described serve to explain the principles ofthe invention and its practical application and to enable others skilledin the art to utilize the invention in various embodiments and withvarious modifications as are suited to the particular use contemplated.Therefore, it is intended that the invention not be limited to theparticular embodiments disclosed for carrying out the invention.

While particular embodiments of the present invention have been shownand described, it will be obvious to those skilled in the art that,based upon the teachings herein, changes and modifications may be madewithout departing from this invention and its broader aspects and,therefore, the appended claims are to encompass within their scope allsuch changes and modifications as are within the true spirit and scopeof this invention. It will be understood by those within the art that,in general, terms used herein are generally intended as “open” terms(e.g., the term “including” should be interpreted as “including but notlimited to,” the term “having” should be interpreted as “having atleast,” the term “includes” should be interpreted as “includes but isnot limited to,” etc.).

What is claimed is:
 1. A method of modifying a tissue, comprising:providing an electrochemical interaction in a tissue; and modifying thetissue by exploiting the electrochemical interaction.
 2. The method ofclaim 1, wherein exploiting the electrochemical interaction comprisesutilizing an electrochemical potentiostat to apply a specific electricalpotential to an array of electrodes.
 3. The method of claim 2, whereinthe electrodes are one or more needle electrodes inserted in the tissue.4. The method of claim 1, wherein exploiting the electrochemicalinteraction comprises potential-driven electromechanical (EMR) and/orpotential-driven electrochemical modification of tissue (PDEMT).
 5. Themethod of claim 1, wherein the electrochemical interaction is optimizedbased on the identification and isolation of one or more discreteelectrochemical reactions that cause shape change of the tissue.
 6. Themethod of claim 1, wherein the electrochemical interaction is optimizedbased on specific electrical dosimetry, electrode placement, and/or typeof composition.
 7. The method of claim 1, wherein the tissue comprises acharged polymer hydrogel.
 8. The method of claim 1, wherein the tissuecomprises cartilage.
 9. The method of claim 1, wherein modifying thetissue is changing the physical shape of the tissue.
 10. The method ofclaim 1, wherein modifying the tissue comprises changing physicalproperties.
 11. The method of claim 10, wherein changing physicalproperties includes mechanical behavior-static and dynamic, electricalbehavior, optical properties, and/or thermal properties.
 12. The methodof claim 1, wherein modifying the tissue comprises changing biologicalbehavior.
 13. The method of claim 12, wherein changing biologicalbehavior includes cell injury, cell death, cell proliferation, shapechange of the tissue, appearance of the tissue, and/or altering drugdelivery properties of the tissue.
 14. The method of claim 1, whereinmodification of the tissue is as part of an overall drug treatmentregimen.
 15. The method of claim 1, wherein the modification of tissueis performed in tandem with one or more defined changes in mechanicalstate in tissue, temperature of tissue, pressure, compression, and/oratmospheric and ambient conditions.
 16. The method of claim 1, whereinexploiting the electrochemical interaction in the subject comprises useof a system comprising one or more electrodes and a control system toapply a precise electrical potential.
 17. A method of treating a diseaseand/or condition in a subject, comprising: defining an electrochemicalinteraction in a constituent of a tissue and/or organ in a subject; andtreating the disease and/or condition by exploiting the electrochemicalinteraction in the subject.
 18. The method of claim 17, whereinexploiting the electrochemical interaction results in altering theconstituent of living tissue.
 19. The method of claim 17, wherein theconstituent is of one or more of the following: ligament, tendons,cornea, ear drum, temporal mandibular joint, vocal cord, muscle, skin,nerve, brain tissue, and/or tumors.
 20. The method of claim 17, whereinthe constituent is of one or more of the following: cartilage, bone,urine, and/or stool.
 21. The method of claim 17, wherein treating thedisease and/or condition is the treatment of one or more biologiccontaminants.
 22. The method of claim 21, wherein the one or morebiologic contaminants include bacteria, fungi, molds, and/or viruses.23. The method of claim 17, wherein exploiting the electrochemicalinteraction in the subject comprises potential-driven electromechanical(EMR) and/or potential-driven electrochemical modification of tissue(PDEMT).
 24. The method of claim 17, wherein the subject is a human. 25.The method of claim 17, wherein the subject is a rabbit.
 26. The methodof claim 17, wherein exploiting the electrochemical interaction in thesubject further comprises placement of working, reference and auxillaryelectrodes in an effective geometric arrangement.
 27. The method ofclaim 17, wherein exploiting the electrochemical interaction in thesubject comprises use of a system comprising one or more electrodes anda control system to apply a precise electrical potential.
 28. A systemfor exploiting an electrochemical interaction in a subject, comprising:one or more electrodes; and a control system to apply a preciseelectrical potential.
 29. The system of claim 28, wherein the controlsystem utilizes a potentiostatic control.
 30. The system of claim 28,wherein the control system utilizes a galvanostatic control.
 31. Thesystem of claim 28, wherein the control system utilizes operationamplifiers.
 32. The system of claim 28, wherein the control systemfurther comprises a feedback control.
 33. The system of claim 32,wherein the feedback control comprises monitoring tissue effect, changein mechanical properties, electrical properties, or optical properties,and total charge transfer.
 34. The system of claim 32, wherein thefeedback control comprises a measure and control of current, potential,charge transfer, pH, concentration of species generated by the system,and/or evolution of gases.
 35. The system of claim 28, wherein the oneor more electrodes comprises a working, reference, and auxiliaryelectrode.
 36. The system of claim 28, wherein the one or moreelectrodes have a static placement.
 37. The system of claim 28, whereinthe one or more electrodes are within a flow through cell.
 38. Thesystem of claim 28, wherein the one or more electrodes have a shape thatis needle, flat plate, curved, clamshell, complex, screen, foam,solid-stiff, soft, pliant, moldable, conforming, and/or liquid.
 39. Thesystem of claim 28, wherein the one or more electrodes are made fromplatinum, iridium, and/or graphite.
 40. The system of claim 28, whereinthe one or more electrodes are coated with a plurality of oxidationcatalysts.
 41. The system of claim 28, wherein the one or moreelectrodes comprise sequestered auxillary electrodes in an isolatedchamber connected by a salt bridge and/or luggin capillary.
 42. Thesystem of claim 28, wherein the one or more electrodes are a referenceelectrode.
 43. The system of claim 28, wherein the one or moreelectrodes are composed of base metals and electro-plated.
 44. Thesystem of claim 28, wherein the applied precise electrical potential ismodulated.
 45. The system of claim 44, wherein the applied preciseelectrical potential is modulated by pulsed, complex or simple waveform,and/or on and off cycles.
 46. The system of claim 28, wherein thecontrol system is adapted for use in conjunction with open surgery,endoscopic delivery, percutaneous, transmucosal, in an air environment,in an aqueous environment, image guided therapies to target specifictissues and/or targets, biopsy, and/or tissue sampling.
 47. The systemof claim 28, wherein the control system is used in tandem with one ormore of the following: agents that activate a pro-genic drug, usercreated changes in tissue composition, injectable drugs, agents thatproduce cross-linking of proteins, agents that alter pH, activate acatalyst for tissue effects, osmotically active agents, salinesolutions, buffers, reactive oxygen scavengers, and chemicals that alterelectrochemistry of the system.
 48. The system of claim 26, furthercomprising a plurality of set of electrodes.
 49. The system of claim 48,wherein the plurality of set of electrodes are used simulatenously or atdifferent times.
 50. The system of claim 48, wherein the plurality ofset of electrodes are used at the same location or spaced apart.
 51. Thesystem of claim 48, wherein the plurality of set of electrodes are in amultiplexing arrangement of the specific chemical reaction desired. 52.The system of claim 28, further comprising using an electrochemistryreaction to generate an active polymerization catalyst.
 53. The systemof claim 52, wherein the electrochemistry reaction is described in FIG.28 herein.
 54. The system of claim 28, further comprising polymerizationof polyanaline, polypyrrole, and/or polythiophene.
 55. A method ofshaping cartilage in a patient, comprising: providing a potential-drivenelectrochemical modification of tissue (PDEMT) and/or potential-drivenelectromechanical (EMR) device; and using the PDEMT and/or EMR device toshape cartilage in the patient.
 56. The method of claim 55, whereinshaping cartilage includes facial structure, lengthening and/ortightening ligaments and tendons, and/or correcting vision in thepatient.
 57. The method of claim 55, wherein cartilage is shaped bywater hydrolysis that results in protonation of fixed negative charges.58. The method of claim 55, further comprising increasing tissueviability by minimizing pH gradients and/or ROS generation.
 59. Themethod of claim 55, wherein the device incorporates bipotentiostatand/or polypotentiostat technology.
 60. A method of treating a cartilagemalformation condition in a patient, comprising: providingpotential-driven electrochemical modification of tissue (PDEMT) and/orpotential-driven electromechanical (EMR) device; and treating thepatient by using the device to shape cartilage.
 61. The method of claim60, wherein the cartilage malformation condition is a nasal tipdeformity, deviated septum, protuberant ear, and/or stenotic trachea.62. The method of claim 60, wherein the device incorporatesbipotentiostat and/or polypotentiostat technology.
 63. The method ofclaim 60, wherein shaping cartilage includes facial structure,lengthening and/or tightening ligaments and tendons, and/or correctingvision in the patient.
 64. An apparatus, comprising: a potential-drivenelectrochemical modification of tissue (PDEMT) and/or potential-drivenelectromechanical (EMR) device adapted for shaping cartilage in apatient.
 65. The apparatus of claim 64, wherein the device incorporatesbipotentiostat and/or polypotentiostat technology.